Understanding the etiology of mental health problems in postrehabilitation COVID-19 patients:Insights and strategies for effective intervention

In this editorial,we comment on an article by Alhammad et al that was published in a recent issue of the World Journal of Clinical Cases(Manuscript No.:91134).We specifically focus on the mental health problems caused by coronavirus disease 2019(COVID-19),their mechanisms,and targeted rehabilitation strategies.Severe acute respiratory syndrome coronavirus 2,via its spike protein,binds to angiotensin-converting enzyme 2 and other receptors prior to infiltrating diverse cells within the central nervous system,including endothelial cells,neurons,astrocytes,and oligodendrocytes,thereby contributing to the development of mental illnesses.Epidemiological data from 2020 underscored the global upsurge in major depressive and anxiety disorders by 27.6%and 25.6%,respectively,during the pandemic.The commented research show that 30%of post-intensive care unit discharge patients with COVID-19 in the Arabic region exhibited Hospital Anxiety and Depression Scale scores that were indicative of anxiety and depression.While acknowledging psychosocial factors,such as grief and loss,it is crucial to recognize the potential neurological impact of the virus through various mechanisms.Accordingly,interventions that encompass dietary measures,health supplements,and traditional Chinese medicine with neuroprotective properties are necessary.This editorial underscores the urgency to implement comprehensive rehabilitation approaches to address the intricate interplay between COVID-19 and mental well-being.

Positive health:An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders

BACKGROUND The concept of positive health(PH)supports an integrated approach for patients by taking into account six dimensions of health.This approach is especially relevant for patients with chronic disorders.Chronic gastrointestinal and hepatopancreatico-biliary(GI-HPB)disorders are among the top-6 of the most prevalent chronically affected organ systems.The impact of chronic GI-HPB disorders on individuals may be disproportionally high because:(1)The affected organ system frequently contributes to a malnourished state;and(2)persons with chronic GIHPB disorders are often younger than persons with chronic diseases in other organ systems.AIM To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders.METHODS Prospective,observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GIHPB disorder attending the Outpatient Department of the Maastricht University Medical Center.Validated questionnaires and data from patient files were used to quantify the six dimensions of PH.Internal consistency was tested with McDonald’s Omega.Zero-order Pearson correlations and t-tests were used to assess associations and differences.A P value<0.05 was considered significant.RESULTS The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population.Regarding quality of life,participation and daily functioning,GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems,but depressive symptoms(in 35%)and malnutrition(in 45%)were more frequent in patients with chronic GI-HPB disorders.Intercorrelation scores between the six dimensions were only very weak to weak,forcing us to quantify each domain separately.CONCLUSION All six dimensions of PH are impaired in the GI-HPB patients.Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Seroprevalence of SARS-COV-2 Exposure among “High-Risk” Populations (Healthcare Workers, People Who Attend Markets, and School Children) in Zanzibar

In Zanzibar, from the start of the pandemic in March 2020 to the time of sampling in December 2020, SARS-CoV-2 seroprevalence data was limited. We conducted a seroprevalence study to evaluate the magnitude of SARS-CoV-2 exposure among healthcare workers, school children, and people who attended general markets in Zanzibar. The objectives of the study were to analyse the total antibodies from selected higher-risk population groups in order to determine magnitude in SARS CoV-2 exposure. Blood samples were collected from eligible and consented participants (adults and children), and their serum was analyzed for total antibodies against SARS-CoV-2 using ELISA. A questionnaire was used to collect participants’ demographic and clinical data. The overall SARS-CoV-2 seroprevalence across all age groups was 33%, and a higher seroprevalence was observed in the 40 - 49 years’ age group relative to other ages as well as in those who attended markets. A runny nose (18.8% of participants) was the most frequently reported SARS-CoV-2 infection-related symptom. Multivariable analysis showed significantly higher odds of infection in people living in urban districts. The findings provide insight into SARS-CoV-2 infection among school children, health workers, and people who attended markets in Zanzibar in the early stages of the pandemic. Exposure in these groups might have been influenced by infection and prevention strategies taken by the government, as well as shopping behavior, school overcrowding, and population density in urban settings. The study had methodological limitations, including cross-sectional design. Further, well-designed, longitudinal studies are recommended to understand exposure and transmission at a population level.

Combinatorial therapies for spinal cord injury repair

Spinal cord injuries have profound detrimental effects on individuals, regardless of whether they are caused by trauma or non-traumatic events. The compromised regeneration of the spinal cord is primarily attributed to damaged neurons, inhibitory molecules, dysfunctional immune response, and glial scarring. Unfortunately, currently, there are no effective treatments available that can fully repair the spinal cord and improve functional outcomes. Nevertheless, numerous pre-clinical approaches have been studied for spinal cord injury recovery, including using biomaterials, cells, drugs, or technological-based strategies. Combinatorial treatments, which target various aspects of spinal cord injury pathophysiology, have been extensively tested in the last decade. These approaches aim to synergistically enhance repair processes by addressing various obstacles faced during spinal cord regeneration. Thus, this review intends to provide scientists and clinicians with an overview of pre-clinical combinatorial approaches that have been developed toward the solution of spinal cord regeneration as well as update the current knowledge about spinal cord injury pathophysiology with an emphasis on the current clinical management.

Secretome of polarized macrophages:potential for targeting inflammatory dynamics in spinal cord injury

Spinal cord injury(SCI)involves an initial traumatic phase,followed by secondary events such as ischemia,increased blood-spinal cord barrier permeability,ionic disruption,glutamate excitotoxicity,and metabolic alterations.A pe rsistent and exagge rated inflammato ry response within the spinal cord accompanies these events(Lima et al.,2022).The complexity and interplay of these mechanisms exacerbate the initial injury,leading to a degenerative process at the injury site.While the initial trauma is unavoidable,the secondary injury begins within minutes and can last for months,creating an optimal window for therapeutic intervention.

Small extrachromosomal circular DNA in amyotrophic lateral sclerosis matter

Comprehensive studies identify motor neuron spectrum disorders including amyotrophic lateral sclerosis(ALS)as globally rising fatal disorders with the highest prevalence in aging populations,influenced by ethnicity and ancestry(GBD 2016 Motor Neuron Disease Colla borators,2018).While~10% of diagnoses involve a family history(fALS),most cases are considered sporadic(sALS).However,population-based studies suggest that even cases without a common index mutation impart heritability(Ryan et al.,2019),indicating a crucial role of rare and as yet unknown genetic denominators.

The human leucocyte differentiation antigens (HLDA) workshops: the evolv-ing role of antibodies in research, diagnosis and therapy

The 8^th International Workshop on Human Leucocyte Differentiation Antigens （chaired by HZ and managed by BS） was run over a 4-year period and culminated in a conference in December 2004. Here we review the achievements of the HLDA Workshops and provide links to information on CD molecules and antibodies against them, including the 93 new CDs assigned in the 8^th Workshop. We consider what remains to be achieved （including an estimate of the number of leucocyte surface molecules still to be discovered）, and how the field can best move forward.

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men

The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen （PSA） levels in healthy men with serum PSA level below 4 ng mL-1. The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment （HOMA [fasting glucose × fasting insulin]/22.5） and quantitative insulin sensitivity check index （QUICK/; 1/[log （fasting insulin） ＋ log （fasting glucose）]）. Age-adjusted body mass index （BMI） was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance （ANOVA） test and Duncan＇s multiple comparison test （P 〈 0.001）, but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICK/（P 〈 0.001）. Age, BMI, insulin resistance by HOMA or QUICK/were significantly independent variables to serum PSA level in a multivariate linear regression analysis （P 〈 0.001）. Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI.

Pluripotent stem cell derived inhibitory interneurons–principles and applications in health and disease

Inhibitory interneurons are gamma-aminobutyric acid-ergic (GABAergic) nerve cells that act to maintain the appropriate excitation-inhibition balance, and synchronise the output of principle cells to generate rhythmic patterns of firing (Kessaris et al., 2014). This critical role, along with their brain-wide distribution, has led to the implication of interneurons in many neuropathologies, including schizophrenia, autism, dystonia and epilepsies (Marín, 2012).

Exercise sustains the hallmarks of health

Exercise has long been known for its active role in improving physical fitness and sustaining health.Regular moderate-intensity exercise improves all aspects of human health and is widely accepted as a preventative and therapeutic strategy for various diseases.It is well-documented that exercise maintains and restores homeostasis at the organismal,tissue,cellular,and molecular levels to stimulate positive physiological adaptations that consequently protect against various pathological conditions.Here we mainly summarize how moderate-intensity exercise affects the major hallmarks of health,including the integrity of barriers,containment of local perturbations,recycling and turnover,integration of circuitries,rhythmic oscillations,homeostatic resilience,hormetic regulation,as well as repair and regeneration.Furthermore,we summarize the current understanding of the mechanisms responsible for beneficial adaptations in response to exercise.This review aimed at providing a comprehensive summary of the vital biological mechanisms through which moderate-intensity exercise maintains health and opens a window for its application in other health interventions.We hope that continuing investigation in this field will further increase our understanding of the processes involved in the positive role of moderate-intensity exercise and thus get us closer to the identification of new therapeutics that improve quality of life.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project

Purpose:This study was aimed to analyze the associations of objectively measured physical activity(PA),sedentary time,and physical fitness with mental health in the early second trimester(16§2 gestational weeks)of pregnancy.Methods:From 229 women initially contacted,124 pregnant women participated in the present cross-sectional study.Data were collected between November 2015 and March 2017.The participants wore Actigraph GT3X+Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time.A performance-based test battery was used to measure physical fitness.Self-report questionnaires assessed psychological ill-being(i.e.,negative affect,anxiety,and depression),and psychological well-being(i.e.,emotional intelligence,resilience,and positive affect).Linear regression analyses were adjusted for age,educational level,accelerometer wear time,miscarriages,and low back pain.Results:Moderate-to-vigorous PA was negatively associated with depression(b=0.222,adjusted R2=0.050,p=0.041).Higher levels of sedentary time were negatively associated with positive affect(b=0.260,adjusted R2=0.085,p=0.017).Greater upper-body flexibility was positively associated with better emotional regulation(b=0.195,adjusted R2=0.030,p=0.047).The remaining associations were not significant(all p>0.05).Conclusion:An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women.Although previous research has focused on the benefits of cardiorespiratory exercise,the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women.If the present findings are corroborated in further experimental research,physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.

A Quasi Experiment to Implement Multimodal Strategy to Improve Hand Hygiene Behavior in a Healthcare Facility in Central Saudi Arabia

Background: Hand hygiene (HH) compliance of healthcare workers (HCWs) remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. Aim: Improve HCWs’ HH compliance toward minimizing healthcare associated infection (HCAI) risk in Wadi Al Dawasir Hospital (WDH), central Kingdom of Saudi Arabia (KSA). Methodology: A quasi experimental approach was adopted to achieve study aim. The HCWs’ behavior of HH during the duration between 2015 and 2016 was evaluated before and after a HH educational plan based on the World Health Organization (WHO) “Multimodal HH Improvement Strategy” (MMHHIS). The HCWs’ compliance in response to HH indications represented by the WHO’s “My 5-Moments for HH” and the type of HH action taken, whether hand washing (HW) or hand-rubbing (HR) were analyzed. Results: The number of opportunities observed of HH performance accounted 230 in 2015 (pre-education), and 237 in 2016 (post-education). The HCWs’ HH compliance rate in the pre-education phase did not vary by the 5-moment indications [χ2(df 4) = 0.01, p = 0.98]. Conversely, the compliance rate after HH education was higher than non-compliance across all 5-moment indication opportunities (ranged between 57.0% up to 88.9%) [χ2(df 1) = 18.25, p rd and 4th 5-moment indications (“after body fluid exposure” and “after patient contact,” respectively) were met with a significant HH improvement [χ2(df 1) = 8.98, p = 0.003;and χ2(df 1) = 16.3, p &#8722;4.38, p = 0.001). Only physicians and nurses showed a significant “within-profession” improvement in HH compliance after education, compared to that before education (Z = &#8722;3.51, p = 0.001, Z = &#8722;2.48, p = 0.013, respectively). Conclusions: Applying a HH education plan based on standardized multimodal HH strategy proved effective in improving the HH compliance of the hospital’s staff. An ongoing observation policy within a HH-resourceful environment assures a sustainable and sound HCWs’ HH behavior.

Relationship between life satisfaction and sympathovagal balance in healthy elderly males at home at night

The aim of this study is to clarify how well-being correlates with autonomic nervous system (sympathovagal) balance in healthy elderly males at home at night awake and resting. The RR-interval and body acceleration of 39 healthy elderly male subjects were recorded with an ambulatory device for 72 hours. The normalized high-frequency (0.15 - 0.4 Hz) power (HFnu) of RR-interval variability (sympathovagal balance index) was calculated from 10 min long data sets that satisfied all of the following conditions: 1) average body acceleration was less than 30 mG, 2) the subject was at home, 3) the subject was awake, and 4) more than 95 percent of the time-series of instantaneous heart rate was within 40 to 160 [bpm]. Subjects recorded their subjective well-being level, including life satisfaction level, on a Visual Analogue Scale (VAS) questionnaire. We investigated the correlation between the subjective well-being level and mean HFnu. A significant negative correlation between life satisfaction level and mean HFnu (r = –0.47, p = 0.004) was observed. This result implies that sympathovagal balance becomes the predominant state of the sympathetic nervous system in healthy elderly males with relatively high life satisfaction while at home at night awake and resting.

The Biological Actions and Mechanisms of Brain-Derived Neurotrophic Factor in Healthy and Disordered Brains

Brain-derived neurotrophic factor (BDNF) is a neurotrophin that elicits neuronal survival and differentiation, synaptic transmission, and the modulation of synaptic plasticity. The biological actions of BDNF are mediated via two distinct receptors: the high-affinity tropomyosin-related kinase B (TrkB) receptor and the low-affinity p75 neurotrophin receptor (p75NTR). Recent findings regarding the actions and mechanisms of BDNF are reviewed here. Activity-dependent synaptic plasticity, as exemplified by long-term potentiation (LTP) and long-term depression (LTD), underlies the cellular mechanism of learning and memory. An accumulating body of evidence shows that BDNF modulates synaptic plasticity. This function requires extracellular neurotrophin release, synaptic activity-dependent local protein synthesis. In addition, a precursor of BDNF, proBDNF, is emerging as a new ligand with biological activities that are distinct from those of BDNF. The proteolytic cleavage of proBDNF is also proposed as a mechanism that determines the direction of BDNF actions. This review discusses the post-translational processing of proBDNF, the modulatory roles of the human BDNF polymorphism Val66Met, recent reports of the novel mechanisms of BDNF expression, and clinical reports showing the roles of BDNF in the blood. Taken together, these data provide new insights into the biological roles of BDNF and its related molecules in the central nervous system.

In-depth examination of hyperproliferative healing in two breeds of Sus scrofa domesticus commonly used for research

Background:Wound healing can result in various outcomes,including hypertrophic scar(HTS).Pigs serve as models to study wound healing as their skin shares physi-ologic similarity with humans.Yorkshire(Yk)and Duroc(Dc)pigs have been used to mimic normal and abnormal wound healing,respectively.The reason behind this differential healing phenotype was explored here.Methods:Excisional wounds were made on Dc and Yk pigs and were sampled and imaged for 98 days.PCR arrays were used to determine differential gene expression.Vancouver Scar Scale(VSS)scores were given.Re-epithelialization was analyzed.H&E,Mason's trichrome,and immunostains were used to determine cellularity,col-lagen content,and blood vessel density,respectively.Results:Yk wounds heal to a“port wine”HTS,resembling scarring in Fitzpatrick skin types(FST)I-III.Dc wounds heal to a dyspigmented,non-pliable HTS,resembling scarring in FST IV-VI.Gene expression during wound healing was differentially regulated versus uninjured skin in 40/80 genes,15 of which differed between breeds.Yk scars had a higher VSS score at all time points.Yk and Dc wounds had equivalent re-epithelialization,collagen disorganization,and blood vessel density.Conclusions:Our findings demonstrate that Dc and Yk pigs can produce HTS.Wound creation and healing were consistent among breeds,and differences in gene expression were not sufficient to explain differences in resulting scar phenotype.Both pig breeds should be used in animal models to investigate novel therapeutics to provide insight into a treatment's effectiveness on various skin types.

Design and implementation of a survey of senior Canadian healthcare decision-makers: Organization-wide resource allocation processes

A three-year research project based in British Columbia, Canada, is attempting to develop a framework and tools to assist healthcare system decision-makers achieve “high performance” in resource allocation. In pursuit of this objective, a literature search was conducted and two phases of primary data collection are being undertaken: an online survey of senior healthcare decision-makers, and in-depth case studies of potential “high performing” organizations. This paper addresses the survey phase;our aim is to provide a practical example of the mechanics of survey design, of benefit to those who want to better understand our forthcoming results, but also as an aid to other researchers grappling with the hard choices and trade-offs involved in the survey development process. Survey content is described in light of the existing literature, with discussion of the choices made by the research team to decide what questions and items would be included and excluded. The target population for the survey was senior managers in Canadian regional health authorities (or the closest equivalent organizations) in each of the 10 provinces and 3 territories. The paper dis- cusses how this sample was obtained, and describes the survey implementation process.

The effects of a 20-week exercise program on blood-circulating biomarkers related to brain health in overweight or obese children:The ActiveBrains project

Background:Emerging research supports the idea that exercise positively affects neurodevelopment.However,the mechanisms linking exercise with brain health are largely unknown.We aimed to investigate the effect of exercise on(a)blood biomarkers selected based on previous evidence(brainderived neurotrophic factor,β-hydroxybutyrate(BHB),cathepsin B(CTSB),kynurenine,fibroblast growth factor 21(FGF21),soluble vascular cell adhesion molecule-1(sVCAM-1));and(b)a panel of 92 neurology-related proteins(discovery analysis).We also investigated whether changes in these biomarkers mediate the effects of exercise on brain health(hippocampal structure and function,cognitive performance,and mental health).Methods:We randomized 81 overweight/obese children(10.1±1.1 years,41%girls)into 2 groups:either 20 weeks of aerobic plus resistance exercise or control.Candidate biomarkers were assessed using enzyme-linked immunosorbent assay(ELISA)for kynurenine,FGF21,and CTSB;colorimetry forβ-hydroxybutyrate;and XMap for brain-derived neurotrophic factor and soluble vascular cell adhesion molecule-1.The92 neurology-related proteins were analyzed by an antibody-based proteomic analysis.Results:Our intervention had no significant effect on candidate biomarkers(all p>0.05).In the discovery analysis,a reduction in circulating macrophage scavenger receptor type-I was observed(standardized differences between groups=-0.3,p=0.001).This effect was validated using ELISA methods(standardized difference=-0.3,p=0.01).None of the biomarkers mediated the effects of exercise on brain health.Conclusions:Our study does not support a chronic effect of exercise on candidate biomarkers.We observed that while chronic exercise reduced the levels of macrophage scavenger receptor type-Ⅰ,it did not mediate the effects of exercise on brain health.Future studies should explore the implications of this novel biomarker for overall health.

Fruit intake associated with urinary estrogen metabolites in healthy premenopausal women

Urinary concentrations of 2:16-hydroxyestrone (2:16-OHE1) approximate concentrations of 2-OHE1 and 16α-OHE1 in breast tissue. As estrogens are purported to be involved in breast cancer development, the 2:16-OHE1 ratio can provide an indication of estrogen metabolite exposure in the breast. With prior studies observing associations between urinary estrogen metabolites and dietary intakeof fruits, vegetables, and fiberascertained from food questionnaires, we examined associations between dietary factors ascertained through 3-day food records and urinary 2:16-OHE1 in191 pre-menopausal healthy women. Fruit consumption was positively associated with 2:16-OHE1 after adjustment for total energy, ethnicity, body mass index, parity, smoking history, and serum estradiol (p = 0.003). Fruit consumption was positively associated with 2-OHE1 concentrations (p = 0.006), but was not associated with 16α-OHE1 (p = 0.92). The Musaceae botanical grouping (comprised primarily of bananas) was positively associated with the 2:16-OHE1 ratio, and Rosaceae (comprised of citrus fruits) and Musaceae botanical groupings were positively associated with 2-OHE1 (but not 16α-OHE1) concentrations, after adjustment for confounders. Our data suggest that dietary fruit intakeis associated with urinary 2-OHE1 and the 2:16-OHE1 ratio and that breast tissue exposure to estrogen metabolites may thus be influenced-by diet.

Managing arterial health in adults with metabolic diseases: Is high-intensity interval exercise the answer? Response to the commentary by Lopes et al.

Dear editor,We thank Lopes et al.^(1) for their interest in our study and for writing an insightful commentary based on our findings,which were recently published in the Journal of Sport and Health Science,^(2) and for their work.^(3) As noted by the authors,there is consistency in several key findings between our laboratories,and this should serve as a basis for future investigation in this area.We agree that there has been little work examining the effect of high-intensity interval exercise(HIIE)on central arterial stiffness.

Healthcare utilization patterns and economic burden of animal bites:A cross-sectional study

Objective:To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province,north part of Iran.Methods:This cross-sectional study was performed based on the data of 12181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020.The study was a societal perspective,and all patients were investigated by census method.The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden.Results:In our study,the economic burden caused by animal bites was estimated at$1383639(275354672060 Rials).The largest share of costs was related to direct healthcare costs,direct non-healthcare costs,and indirect costs accouting for 91%,5%,and 4%,respectively.In addition,the average cost of a animal-bite patient was estimated at$113.5(22605260 Rials)(The average cost of a case in type 2 and 3 exposures was$45 and$412.8,respectively).The largest share of direct healthcare costs was related to immunoglobulin,vaccine,and personnel expenses accounting for 61.3%,19.8%,and 11.65%,respectively.Conclusions:Our study shows that animal bites in Golestan province,north of Iran impose a high economic burden on the communities,especially the healthcare system,which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.